Concussion awareness appears to be hitting the slopes, as more skiers and snowboarders wear helmets, and ski areas try various approaches to boost safety and limit head injuries.

Nashoba Valley Ski Area in Westford, Blue Hills Ski Area in Canton, Ski Ward in Shrewsbury, and Wachusett Mountain Ski Area in Princeton all recommend helmet use, which is fast becoming the norm on trails and in terrain parks.

But each operation is using different methods to address safety concerns, which are increasing as researchers learn more about head injuries and concussions.

Safety helmets decrease both the risk and severity of head injuries in recreational skiing and snowboarding, and should be strongly recommended, according to an article published last month in the Journal of Trauma and Acute Care Surgery. The medical journal’s article, a review of 16 previously published studies, stated that policies should be promoted to increase helmet use.

Many ski areas have already started encouraging the use of helmets, and some are trying to do more. For the third year, Ski Ward is requiring skiers and snowboarders to watch a safety video before entering the terrain park, which features a variety of rails and mounds for jumps and more acrobatic moves. People using the traditional downhill slopes do not have to watch the video.

“Our focus has really become the park,” said Jen Andersen, general manager of Ski Ward, which recently opened for the season.

The terrain park is limited to advanced skiers or snowboarders who are at least 8 years old. And when the operators see someone who shouldn’t be there?

“We tell them, ‘You’re not ready to be in here yet,’ ” said Andersen. They don’t tell people to leave, she said, because generally a warning is enough.

The safety video
states that wearing a helmet could save their lives.

“It used to be no one would do it,” said Andersen. “Now almost 100 percent of the people in the park wear them.”

According to the National Ski Areas Association, which has been tracking the practice for a decade, helmet usage is up nationwide, going from 25 percent of skiers and riders in the 2002-2003 season to 67 percent last winter. In the Northeast, which covers New England plus New York, the rate was even higher last winter, at 75 percent.

The lowest rates are among 18- to 24-year-olds, who nationwide wear helmets 53 percent of the time, according to the association.

“The key for us is that while we certainly recommend helmets, we strongly emphasize that skiing and boarding safely is the best overall way to reduce the chances for injuries,” said Dave Byrd, director of risk and regulatory affairs for the association, in an e-mailed statement. “One helpful way to look at it is: Wear a helmet, but ski and snowboard as if you are not.”

His association officially recommends helmets, and sponsors a campaign aimed at youngsters, Lids on Kids. It also has supported bills in various states to require helmets, Byrd said, although only New Jersey has passed such a law, which went into effect last season. His group would not support a bill that required ski areas to be the enforcers, he said.

A big part of public education, unfortunately, is when someone famous has a ski accident, he said. For example, actor Natasha Richardson died from a head injury sustained in Quebec in 2009 while skiing without a helmet, and the issue was spotlighted in the news media for weeks.

Last winter, there were 54 fatalities at ski areas nationwide, and in 36 of the accidents the victim was wearing a helmet, according to a spokesman for the national industry group, Troy Hawks. The figure was higher than the 2010-11 season, when there were 47 deaths, with 21 of the skiers or boarders wearing a helmet, Hawks said, and well above the annual average — 41.5 — over the last 10 years.

Fatalities from head injuries while skiing or boarding have been relatively uncommon at Massachusetts ski areas.

In 2008, a 17-year-old from Westport who was not wearing a helmet veered off an intermediate trail at Wachusett, hit a tree, and died from head injuries, according to an Associated Press article. In 2006, a 39-year-old Dudley resident died of a head injury while skiing at Wachusett after he tried to avoid hitting a child and lost control.

In an attempt to prevent injuries, Wachusett has long had not only a ski patrol but also a ranger program, with experienced skiers who teach safety and look for possible problem behavior. The ranger program was stepped up after both fatalities, said Mike Halloran, ski patrol director at Wachusett.

“It just makes us more aware,” he said. “It’s a tragic situation and everyone is a little more conscious about what’s going on.”

Wachusett doesn’t see many head injuries, he added. “The main thing with these injuries is these people with a helmet, too, they’re overconfident when they put it on their head,” Halloran said.

That’s a prevalent concern. Al Fletcher, president of the Nashoba Valley Ski Area, said one of the reasons helmets are recommended but not required is because of the potential for neck injuries — if a helmet gets caught on something, for example.

“We would never mandate something like that because what if someone got one of those sorts of injuries, and wouldn’t have if they didn’t have it on,” he said. “We as a ski area recommend the use because more often than not it can help you.”

No ski areas require all skiers to wear a helmet, according to association spokesman Byrd, although some mandate them for youngsters taking lessons.

Helmet concerns were also addressed in the review of studies published last month. Researchers, including lead author Adil H. Haider, an associate professor at Johns Hopkins University, found that helmets do not appear to increase so-called “risk compensation” behavior, neck injuries, or cervical spine injuries.

Nashoba, like many other ski areas, uses Lids on Kids
materials to get the attention of young skiers and boarders. Its website, www.lids­onkids.org, emphasizes the importance of a good fit, has tips for parents, and includes research on
the topic.

Vero Piacentini, general manager of the Blue Hills Ski Area in Canton, said people ask whether they can use a hockey or bike helmet while skiing, but Blue Hills advises against such substitution helmets because they are not designed for the sport’s winter conditions.

Although he has noticed more people using helmets in recent years, Piacentini said, skiers and boarders aren’t thinking about head injuries the way that some other athletes do.

“I don’t know that people associate skiing with the typical sports injuries,” he said. “I listen to the radio and they’re talking about football as the primary thing that’s taking up all the news. I don’t know that people think of skiing as a contact sport.”